POS0362 FACTORS ASSOCIATED WITH CHANGES IN COPING BEHAVIOUR IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS - A LONGITUDINAL STUDY OF THE LuLa COHORT
Authors: E. Reutemann, R. Brinks, J. G. Richter, R. Fischer-Betz, B. Winkler-Rohlfing, M. Aringer, M. Schneider, G. Chehab
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with Systemic Lupus Erythematosus (SLE) experience both physical and psychosocial restrictions that negatively impact their quality of life. Coping mechanisms have turned out to be important contributors to health-related outcomes, not only in SLE but also other chronic conditions. However, there is limited understanding of factors that enhance or hamper coping in SLE. Objectives To analyse parameters associated with longitudinal changes in coping behaviour in patients with SLE who take part in a long-term SLE patient cohort study. Methods Since 2001, the German nationwide SLE patient longitudinal (Lupus Langzeit ‘LuLa’) study annually administers self-reported questionnaires to SLE patients. In addition to demographic and the annually probed extended clinical data (e.g., medication, disease activity, fatigue, depression), in both 2009 and 2014 we assessed the Pain-related Self Statements Scale (PRSS) to perceive information related to coping behaviour. This includes ‘positive coping’ as well as catastrophizing as a dysfunctional form of coping behaviour. Statistical analysis was accomplished by a linear regression model adjusting for age, pain, number of comorbidities and net income. The PRSS score difference from 2009 and 2014 was used as the dependent variable. Factors from the i) medical (involvement of the skin, pain, fatigue), ii) activity (basic, leisure, sports), iii) intrinsic (depression, kinesiophobia, perceived health control), and iv) social participation categories were entered as independent variables. Results 272 patients (96.7% female) provided valid PRSS questionnaires in both 2009 and 2014. In 2009 the mean age in this cohort was 51 years (SD 11.2) with an average disease duration of 16.2 years (SD 8.3). The mean reported lupus activity (VAS 0-10) during the last three months was 3.7 (SD 2.4). During the six-year observation period, the proportion of improvement (46.2%) and deterioration (47.4%) in coping score was almost balanced, while in catastrophizing score more participants improved (50.0%) than deteriorated (37.0%). A perceived high internal control, thus the belief that health outcomes are contingent on personal behaviour, was associated with an improvement in the coping score [HLC, b=0.061 (95%-CI 0.014; 0.109), p=0.012]. Conversely, high external control convictions, e.g., the belief that doctors and other third parties determine health outcomes, were associated with a worse coping score [HLC, b=-0.090 (95%-CI -0.154; -0.026), p=0.006]. Deterioration in depression [ADS-L, b=0.015, (95%-CI 0.006; 0.025), p=0.002] and impaired social participation [IMET, b=0.043, (95%-CI 0.000; 0.085), p=0.050] were associated with a deterioration of catastrophizing, whereas better internal control [HLC, b=-0.046, (95%-CI -0.080; -0.012), p=0.009] was associated with its improvement. Mucocutaneous involvement, fatigue and the extent of physical activity were not significantly associated with either coping or catastrophizing scores in the regression analysis. Conclusion In line with data from other chronic diseases, our findings in a longitudinal SLE cohort emphasise the role of intrinsic factors, such as mental health status and self-efficacy, improving the quality of life in SLE patients via successful coping behaviour. Affirmative action measures and programs to improve social participation may yield additional benefits. Acknowledgements The LuLa study is supported by unrestricted grants from GlaxoSmithKline, UCB Pharma and AstraZeneca. Disclosure of Interests Emily Reutemann: None declared, Ralph Brinks: None declared, Jutta G. Richter Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Rebecca Fischer-Betz Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Borgi Winkler-Rohlfing: None declared, Martin Aringer: None declared, Matthias Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Gamal Chehab Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study.